Claims Specialist
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Claims Specialist managing and resolving pharmacy claims efficiently at PharMerica. Collaborating with teams to enhance patient care through meticulous claims management.
Responsibilities:
- Leverage your Pharmacy Claims Experience to manage and resolve claims efficiently, ensuring our clients get the support they need.
- Be a vital part of a team that’s dedicated to enhancing patient care through meticulous claims management and customer service.
- Manages and identifies a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks.
- Researches, analyzes and appropriately resolves rejected claims by working with national Medicare D plans, third party insurance companies and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines.
- Ensures approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement.
- Monitors and resolves at risk revenue associated with payer set up, billing, rebilling and reversal processes.
- Works as a team to identify, document, communicate and resolve payer/billing trends and issues.
- Reviews and works to convert billing exception reports to ensure claims are billed to accurate financial plans.
- Prepares and maintains reports and records for processing.
- Performs other tasks as assigned.
Requirements:
- High School Diploma or GED
- Desired: Associate’s or Bachelor’s Degree
- Required: Customer Service
- Desired: Up to one year of related experience.
- Pharmacy Technician experience
- Required: Ability to retain a large amount of information and apply that knowledge to related situations.
- Ability to work in a fast-paced environment.
- Basic math aptitude.
- Microsoft Office Suite
- Desired: Knowledge of the insurance industry’s trends, directions, major issues, regulatory considerations and trendsetters
- Desired: Pharmacy technician, but not required.
Benefits:
- DailyPay
- Flexible Schedules
- Competitive Pay with Shift Differentials
- Health, Dental, Vision, and Life Insurance
- Company-Paid Disability Insurance
- Tuition Assistance & Reimbursement
- Employee Discount Program
- 401k Plan
- Paid Time Off
- Non-Retail, Closed-Door Environment
Similar Jobs
Lost Time Claims Adjuster – Workers' Compensation
Managing lost time and medical only Workers' Compensation claims at Encova Insurance. Collaborating with various stakeholders and ensuring proper claim management.
Claims Specialist
Claims Specialist responsible for supporting Clinical Research billing and account review for Providence Health System. Reviewing clinical billing accuracy and compliance while collaborating with research entities.
Claims Examiner - Workers Compensation
Claims Examiner managing complex water damage claims for Sedgwick. Analyzing, negotiating, and ensuring timely adjudication of claims in a supportive environment.
Claims Coordinator I
Claims Coordinator I responsible for entering claims data into the system and supporting claim adjusters in a remote setting. Role involves administrative duties related to handling claims inquiries and notifications.
Field Property Claims Adjuster
Field Property Claims Adjuster for Farmers conducting virtual and on-site investigations of property damage. Negotiating settlements and engaging with stakeholders in claims process.
Claims Representative – Personal Property
Claims Representative investigating personal property damage claims for ClaimsPro LP in remote role while ensuring compliance with state regulations. Communication with insured and evaluative duties for claims settlement.
Field Property Claims Adjuster
Field Property Claims Adjuster conducting investigations on property damage for Farmers Insurance. Using software and customer service skills to negotiate settlements and represent the company.
Field Property Claims Adjuster
Field Property Claims Adjuster at Farmers visiting policyholders’ homes to investigate property damage claims. Utilizing claims handling software and negotiating settlements with customers.
Field Property Claims Adjuster
Field Property Claims Adjuster assessing property damage through investigations and engaging with various stakeholders. Conducting virtual and on-site visits to negotiate settlements for claims.
Field Property Claims Adjuster
Field Property Claims Adjuster at Farmers Insurance visiting policyholders’ homes to assess property damage and negotiate settlements. Engaging with a variety of stakeholders including claimants and law enforcement.
Field Property Claims Adjuster
Field Property Claims Adjuster conducting both virtual and on-site investigations of property damage for Farmers Insurance. Evaluating claims, negotiating settlements, and representing the company in public interactions.
Field Property Claims Adjuster
Field Property Claims Adjuster with Farmers Insurance conducting investigations and negotiating settlements for property damage. Requires travel to policyholders’ residences and a strong customer service focus.
Field Property Claims Adjuster
Field Property Claims Adjuster visiting policyholders to assess property damage and negotiate settlements. Join Farmers Insurance, a leader in providing peace of mind through insurance solutions.
Field Property Claims Adjuster
Field Property Claims Adjuster responsible for investigating property damage for a reputable insurance company. Engaging with policyholders and using claims software to write estimates and settle claims.
Claims Examiner Manager
Claims Examiner Manager supporting federal claims management program. Conducting claims intake, investigation, research, documentation, and case administration activities.
Claims Examiner I
Claims Examiner I conducting claims intake and investigation while ensuring compliance with procedures. Collaborating with senior claims personnel and maintaining electronic case files.
Claims Specialist
Claims Specialist processing Wellness and Hospital Indemnity insurance claims for Aflac. Providing customer service and documentation for policyholders while utilizing database systems.
Claims Examiner – Reinsurance
Claims Examiner (Reinsurance) responsible for overseeing reinsurance claims management and compliance. Collaborating with claims teams to support optimal recoveries and accurate reporting within the United States.
Revenue Cycle Claims Specialist
Revenue Cycle Claims Specialist optimizing revenue cycle operations for autism care providers at Finni Health. Collaborating with teams to enhance billing, claims processing, and compliance.
Bodily Injury Claims Adjuster, Trucking
Claims Adjuster handling commercial transportation claims for Reserv. Providing customer service and managing claims effectively with a focus on quick resolutions.